Organization
EVERGREEN MEDICAL COSMETIC LASER CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIAN HUAI FONG MD (MD)
(205) 834-2672
Entity
Organization
Contact information
Practice address
104 1ST AVE EAST, ONEONTA, AL 35121
(205) 834-2672
Mailing address
1638 CROSSGATE DR, BIRMINGHAM, AL 35216
(205) 834-2672
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
27530
AL
Other
Enumeration date
06/20/2013
Last updated
06/20/2013
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